[Prospective controlled study comparing laparoscopy and the Shouldice technique in the treatment of unilateral inguinal hernia]. / Etude prospective contrôlée comparant laparoscopie et Shouldice dans le traitement de la hernie inguinale unilatérale.

Between October 1992 and September 1994, 70 patients presenting with primary unilateral hernia were randomly assigned to either a transabdominal preperitoneal laparoscopic (group L) repair (n = 35) with a 3 x 5 inch polypropylene mesh or a conventional Shouldice repair (group S) (n = 35). The series consisted of 60 men and 10 women, with a median age of 56 years and a BMI of 24. We used the Nyhus classification; there were 25 type 2, 24 type 3a and 21 type 3b hernias. Preoperative characteristics of both groups were equivalent. When comparing group L to group S, we noted a similar operative time (65 +/- 20 min) and a similar postoperative hospital stay (3.8 +/- 1.3 days). The postoperative pain that was evaluated on a visual analogue scale (score from 0 to 10) was lower in group L. On the first and third postoperative day, the mean score was 3.4 +/- 1.5 and 1.3 +/- 1.4 in (group L compared) to 5.3 +/- 1.9 (p < 0.001) and 2.8 +/- 1.8 (p < 0.005) in group S. Significant morbidity occurred in 7 patients of group L: 3 seromas and 4 cases of orchitis, and in 5 patients of group S: 1 wound abcess, 2 cases of chronic neuralgia and 2 cases of orchitis. We recorded a quicker return to home activities in group L: 6 +/- 2 versus 10 +/- 4 days (p < 0.05) in group S but time off work was similar in both groups (30 +/- 9 days). All patients were evaluated in April 1996: the median follow-up was 30 months (range: 19-42 months). We recorded 1 recurrence in group L and 3 in group S. Statistical analysis revealed that the recurrence rate, for patients older than 50 and presenting with type 3 hernia, was higher in group S (3/14 = 21%) than in group L (0/13 = 0%). In conclusion, compared to Shouldice repair, laparoscopic herniorrhaphy is associated with less postoperative pain, a quicker return to everyday activities and an equivalent postoperative morbidity. In our series, the recurrence rate was even lower for patients older than 50 with type 3 hernia.

Prospective analysis of 192 consecutive cholecystectomies: a comparative study between laparoscopy and laparotomy.

The hospital records of all the patients who underwent cholecystectomy because of specific biliary symptoms, between October 1990 and March 1993, were prospectively analyzed. The series consisted of 192 patients (159 women and 33 men), the mean age was 56 years and the mean body mass index was 26. Indication for surgery was uncomplicated gallstones in 113, common bile duct stones in 28 and cholecystitis in 51 patients. In those groups, respectively 94 (83%), 16 (57%) and 23 (45%) patients had a laparoscopic cholecystectomy. In total, laparoscopic cholecystectomy was successfully performed in 127 (95%) of the 133 patients in whom it was attempted. When compared with laparotomy, laparoscopic cholecystectomy was associated with shorter operative time: 88 +/- 41 min. (Mean +/- SD) versus 132 +/- 64 min. (p < 0,001), shorter postoperative hospital stay: 5 +/- 3 days versus 13 +/- 7 days (p < 0.001) and reduced cost of hospitalization: 103.301 +/- 51.062 BF versus 186.931 +/- 113.651 BF (p < 0.001). We noted an equivalent perioperative morbidity incidence in the two groups. The advantages of laparoscopy compared to laparotomy were recorded whatever the indication for cholecystectomy was. Therefore, with the increasing experience of surgeons and the improving quality of laparoscopic instruments, we think that laparoscopy can be considered for all patients requiring cholecystectomy.

[Haematic pseudo-cysts of the adrenal. About three cases (author's transl)]. / Les pseudo-kystes hématiques de la surrénale. A propos de 3 observations.

The authors report 3 cases of haematic cysts of the adrenal, discovered in young adults (3 female), presenting with lumbar or lumbo-abdominal pain, sometimes violent, and accompanied by fever. In each cases there was a palpable swelling in the hypochondrium and lumbar fossa. In two cases severe anaemia reflected the amount of haemorrhage which had taken place. IVU with a prolonged vascular nephrotomography time with several views and echotomography confirmed the diagnosis, avoiding the need for aortography whenever possible. The size of the cysts was such that adrenalectomy was necessary in two cases and the extent of adhesions required simultaneous nephrectomy. This is followed by a review of the literature, the dominant features being: the prevalence of haematic cysts which account for 40% of adrenal cysts, the absence of specificity of clinical symptoms and signs and the importance of radiological examinations, and finally the usual absence of any cause even though trauma may sometimes be possible.